Extended use zirconium silicate compositions and methods of use thereof

ABSTRACT

The present invention relates to zirconium silicate compositions having a lead content that is below 0.6 ppm and methods of manufacturing zirconium silicate at reactor volumes exceeding 200-L with a lead content below 1.1 ppm. The lead content of the zirconium silicate of this invention are within the levels that are considered acceptable for extended use given the dose requirements for zirconium silicate.

CROSS REFERENCE TO RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No.14/883,428 filed Oct. 14, 2015. The disclosure of the prior applicationis hereby incorporated in its entirety by reference.

BACKGROUND OF THE INVENTION

(i) Field of the Invention

The present invention relates to novel microporous zirconium silicatecompositions that are formulated to remove toxins, e.g., potassium ionsor ammonium ions, from the gastrointestinal tract at an elevated ratewithout causing undesirable side effects. The compositions aremanufactured to exhibit desired characteristics for the long termadministration to treat or prevent the relapse or occurrence of certainconditions, i.e., hyperkalemia.

(i) Description of the Related Art

Acute hyperkalemia is a serious life threatening condition resultingfrom elevated serum potassium levels. Potassium is a ubiquitous ion,involved in numerous processes in the human body. It is the mostabundant intracellular cation and is critically important for numerousphysiological processes, including maintenance of cellular membranepotential, homeostasis of cell volume, and transmission of actionpotentials. Its main dietary sources are vegetables (tomatoes andpotatoes), fruit (oranges, bananas) and meat. The normal potassiumlevels in plasma are between 3.5-5.0 mmol/l with the kidney being themain regulator of potassium levels. The renal elimination of potassiumis passive (through the glomeruli) with active reabsorption in theproximal tubule and the ascending limb of the loop of Henle. There isactive excretion of potassium in the distal tubules and the collectingduct, both of which processes are controlled by aldosterone.

Increased extracellular potassium levels result in depolarization of themembrane potential of cells. This depolarization opens somevoltage-gated sodium channels, but not enough to generate an actionpotential. After a short period of time, the open sodium channelsinactivate and become refractory, increasing the threshold to generatean action potential. This leads to impairment of the neuromuscular-,cardiac- and gastrointestinal organ systems, and this impairment isresponsible for the symptoms seen with hyperkalemia. Of greatest concernis the effect on the cardiac system, where impairment of cardiacconduction can lead to fatal cardiac arrhythmias such as asystole orventricular fibrillation. Because of the potential for fatal cardiacarrhythmias, hyperkalemia represents an acute metabolic emergency thatmust be immediately corrected.

Hyperkalemia may develop when there is excessive production of serumpotassium (oral intake, tissue breakdown). Ineffective elimination,which is the most common cause of hyperkalemia, can be hormonal (as inaldosterone deficiency), pharmacologic (treatment with ACE-inhibitors orangiotensin-receptor blockers) or, more commonly, due to reduced kidneyfunction or advanced cardiac failure. The most common cause ofhyperkalemia is renal insufficiency, and there is a close correlationbetween degree of kidney failure and serum potassium (S-K) levels. Inaddition, a number of different commonly used drugs cause hyperkalemia,such as ACE-inhibitors, angiotensin receptor blockers, potassium-sparingdiuretics (e.g. amiloride, spironolactone), NSAIDs (such as ibuprofen,naproxen, celecoxib), heparin and certain cytotoxic and/or antibioticdrugs (such as cyclosporin and trimethoprim). Finally, beta-receptorblocking agents, digoxin or succinylcholine are other well-known causesof hyperkalemia. In addition, advanced degrees of congestive heartdisease, massive injuries, burns or intravascular hemolysis causehyperkalemia, as can metabolic acidosis, most often as part of diabeticketoacidosis.

Symptoms of hyperkalemia are somewhat non-specific and generally includemalaise, palpitations and muscle weakness or signs of cardiacarrhythmias, such as palpitations, brady-tachycardia ordizziness/fainting. Often, however, the hyperkalemia is detected duringroutine screening blood tests for a medical disorder or after severecomplications have developed, such as cardiac arrhythmias or suddendeath. Diagnosis is obviously established by S-K measurements.

Treatment depends on the S-K levels. In milder cases (S-K between 5-6.5mmol/l), acute treatment with a potassium binding resin (Kayexalate®),combined with dietary advice (low potassium diet) and possiblymodification of drug treatment (if treated with drugs causinghyperkalemia) is the standard of care; if S-K is above 6.5 mmol/l or ifarrhythmias are present, emergency lowering of potassium and closemonitoring in a hospital setting is mandated. The following treatmentsare typically used:

Kayexalate®, a resin that binds potassium in the intestine and henceincreases fecal excretion, thereby reducing S-K levels. However, asKayexalate® has been shown to cause intestinal obstruction and potentialrupture. Further, diarrhea needs to be simultaneously induced withtreatment. These factors have reduced the palatability of treatment withKayexalate®.

Insulin IV (+glucose to prevent hypoglycemia), which shifts potassiuminto the cells and away from the blood.

Calcium supplementation. Calcium does not lower S-K, but it decreasesmyocardial excitability and hence stabilizes the myocardium, reducingthe risk for cardiac arrhythmias.

Bicarbonate. The bicarbonate ion will stimulate an exchange of K+ forNa+, thus leading to stimulation of the sodium-potassium ATPase,dialysis (in severe cases).

The only pharmacologic modality that actually increases elimination ofpotassium from the body is Kayexalate®; however, due to the need toinduce diarrhea, Kayexalate® cannot be administered on a chronic basis,and even in the acute setting, the need to induce diarrhea, combinedwith only marginal efficacy and a foul smell and taste, reduces itsusefulness.

The use of zirconium silicate or titanium silicate microporous ionexchangers to remove toxic cations and anions from blood or dialysate isdescribed in U.S. Pat. Nos. 6,579,460, 6,099,737, 6,332,985 and U.S.2004/0105895, each of which is incorporated herein in their entirety.Additional examples of microporous ion exchangers are found in U.S. Pat.Nos. 6,814,871, 5,891,417, and 5,888,472, each of which is incorporatedherein in their entirety.

The inventors have found that known zirconium silicate compositions mayexhibit undesirable effects when utilized in vivo for the removal ofpotassium in the treatment of hyperkalemia. Specifically, the inventorsfound that administration of zirconium silicate molecular sievecompositions is associated with an incidence of mixed leukocyteinflammation, minimal acute urinary bladder inflammation and theobservation of unidentified crystals in the renal pelvis and urine inanimal studies, as well as an increase in urine pH. The inventorsaddressed these problems by controlling particle size and sodium contentof the zirconium silicate compositions. See U.S. Pat. Nos. 8,802,152 and8,808,750, each of which is incorporated herein in their entirety.

Further, known zirconium silicate compositions have had issues withcrystalline impurities and undesirably low cation exchange capacity. Thereduction of more soluble forms of zirconium silicate is important toreduce or eliminate the systemic absorption of zirconium or zirconiumsilicate. The inventors addressed this issue by controlling productionconditions in a way that essentially eliminates ZS-8 from thecomposition, resulting in undetectable levels of ZS-8. See U.S. Pat. No.8,877,255.

The inventors have found that certain zirconium silicate compositionsare useful for long term use, for example, in the treatment ofconditions associated with elevated levels of serum potassium. The useof zirconium silicate compositions in long term treatment regimensrequires careful control of impurities, particularly lead, in thecomposition. For example, the FDA sets the acceptance criteria for leadin compositions for extended use at 5 micrograms per day. The inventorshave found that zirconium silicates produced using known methods inindustrial quantities contain approximately 1 to 1.1 ppm or more oflead. Even when zirconium silicate was prepared in smaller batches athigher purity (i.e., using reagent grade starting materials availablefrom Sigma-Aldrich), the level of lead was found to be 0.6 ppm or more.Because zirconium silicate treatments utilize doses ranging from 5 to 45grams per day, reduction in the level of lead is necessary. The presentinvention relates to compositions of zirconium silicate having leadcontent within an acceptable range necessitated by the daily doses ofzirconium silicate.

SUMMARY OF THE INVENTION

The present invention relates to cation exchange compositions comprisinga zirconium silicate of formula (I):A_(p)M_(x)Zr_(1-x)Si_(n)Ge_(y)O_(m)  (I)where

-   -   A is a potassium ion, sodium ion, rubidium ion, cesium ion,        calcium ion, magnesium ion, hydronium ion or mixtures thereof,    -   M is at least one framework metal, wherein the framework metal        is hafnium (4+), tin (4+), niobium (5+), titanium (4+), cerium        (4+), germanium (4+), praseodymium (4+), terbium (4+) or        mixtures thereof,    -   “p” has a value from about 1 to about 20,    -   “x” has a value from 0 to less than 1,    -   “n” has a value from about 0 to about 12,    -   “y” has a value from 0 to about 12,    -   “m” has a value from about 3 to about 36 and 1≤n+y≤12,    -   wherein the composition exhibits a lead content below 0.6 ppm.        Preferably, the lead content ranges from 0.1 and 0.6 ppm, more        preferably from 0.3 to 0.5 ppm, and most preferably from 0.3 to        0.45 ppm. In one embodiment, the lead content is 0.38 ppm. The        present invention also relates to manufacturing zirconium        silicate at reaction volumes at or exceeding 200-L where the        lead content is below 1.1 ppm. In this embodiment, the lead        content ranges from 0.1 and 1.1 ppm, more preferably from 0.3 to        0.5 ppm, and most preferably from 0.3 to 0.45 ppm.

In addition to having a desired level of lead impurity, the compositionmay exhibit one or more properties that make it desirable as an orallyingested ion trap. In one aspect, the zirconium silicate composition mayhave a potassium exchange capacity exceeding 2.3 meq/g, preferablyranging from 2.3 to 3.5 meq/g, more preferably within the range of 3.05and 3.35 meq/g, and most preferably about 3.2 meq/g. In one embodiment,7% of the particles in the composition have a diameter less than 3microns. In other embodiments less than 0.5% of the particles in thecomposition have a diameter less than 1 microns. Preferably, the sodiumcontent is below 12% by weight, and more preferably 9% or less byweight. The zirconium silicate preferably exhibits an XRD diffractogramhaving the two highest peaks occurring at approximately 15.5 and 28.9,with the highest peak occurring at 28.9. The material is preferablyZS-9, or predominately ZS-9, having a pH ranging from 7 to 9 and apotassium loading capacity between 2.7 and 3.7 mEq/g, and mostpreferably approximately 3.5.

The invention also relates to methods of administration of the abovezirconium silicate compositions. In one preferred embodiment, thezirconium silicate compositions are administered over a period of morethan 5 consecutive days.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a polyhedral drawing showing the structure of zirconiumsilicate Na_(2.19)ZrSi_(3.01)O_(9.11)*2.71H₂O (MW 420.71)

FIG. 2 shows a schematic drawing of a reaction vessel with baffles forproduction of zirconium silicate.

FIG. 3 shows a diagram of the processing equipment used to producezirconium silicate.

FIG. 4 shows particle size distribution of a zirconium silicate preparedaccording to Example 3.

FIG. 5 shows an XRD plot for zirconium silicate prepared according toExample 3.

DETAILED DESCRIPTION OF THE INVENTION

The inventors have discovered novel zirconium silicate molecular sieveabsorbers that address the need for extended use compositions having alow impurity profile. The zirconium silicate compositions meet theperformance criteria for previously described zirconium silicatecompositions, but also exhibit reduced impurities, particularly lead,which make the compositions suitable for extended use.

The inventors have designed a reactor for larger-scale production ofhigh purity, high-KEC ZS-9 crystals. See U.S. Pat. Nos. 8,802,152;8,808,750; and 8,877,255. The reactor 200 has baffle structures 204 onits sidewalls, which in combination with the agitator 201 providesignificant lift and suspension of the crystals during reaction and thecreation of high purity, high KEC ZS-9 crystals. FIG. 2. The improvedreactor can also include a cooling or heating jacket for controlling thereaction temperature during crystallization in addition to the bafflestructures 204. Preferably the reactor has a volume of at least 20-L,more preferably 200-L, 500-L, 2000-L, or 5000-L, and within the range of200-L to 30,000-L.

The process flow for production of zirconium silicate is shown in FIG.3. To a reactor are added a silicate source. The prior processes capableof manufacturing zirconium silicate having the desired characteristicsfor oral administration used sodium silicate as a source of silicate.The process also uses 50% NaOH solution, water and zirconium acetatewhich are charged to the reactor shown in FIG. 3. Also shown is a dryerin which the raw zirconium silicate product is fed. The zirconiumsilicate is cleaned, protonated and dried in the drier to produce thedesired zirconium silicate along with aqueous waste material.

As discussed below in Example 2, the silicate source is colloidal silica(Ludox®) rather than sodium silicate. The inventors found that replacingthe sodium silicate in known processes for manufacturing high qualityzirconium silicates is ineffective. The present invention is based onthe inventors' discovery that the reactor should not be initiallycharged with the colloidal silica but instead added to previously mixedsodium hydroxide and water. In addition, the agitation rate must beincreased after addition of the colloidal silica for at least twentyminutes in order to break silica bonds and obtain a well mixed solution.Additional aspects of the inventive process can be understood byreference to Example 2 below.

The zirconium silicate according to the invention exhibits a leadcontent below 1 ppm. More preferably, the lead content ranges from 0.1and 0.8 ppm, more preferably from 0.3 to 0.6 ppm, and most preferablyfrom 0.3 to 0.45 ppm. In one embodiment, the lead content is 0.38 ppm.

Comparative Example 1

High capacity ZS-9 crystals were prepared in accordance with thefollowing representative example.

The reactants were prepared as follows. A 22-L Morton flask was equippedwith an overhead stirrer, thermocouple, and an equilibrated additionfunnel. The flask was charged with deionized water (8,600 g, 477.37moles). Stirring was initiated at approximately 145-150 rpm and sodiumhydroxide (661.0 g, 16.53 moles NaOH, 8.26 moles Na₂O) was added to theflask. The flask contents exothermed from 24° C. to 40° C. over a periodof 3 minutes as the sodium hydroxide dissolved. The solution was stirredfor an hour to allow the initial exotherm to subside. Sodium silicatesolution (5,017 g, 22.53 mole SO2, 8.67 moles Na₂O) was added. Thesodium silicate was available from Sigma-Aldrich. To this solution, bymeans of the addition funnel, was added zirconium acetate solution(2,080 g, 3.76 moles ZrO₂) over 30 min. The resulting suspension wasstirred for an additional 30 min.

The mixture was transferred to a 5-G Parr pressure vessel Model 4555with the aid of deionized water (500 g, 27.75 moles). The reactor wasfitted with a cooling coil having a serpentine configuration to providea baffle-like structure within the reactor adjacent the agitator. Thecooling coil was not charged with heat exchange fluid as it was beingused in this reaction merely to provide a baffle-like structure adjacentthe agitator.

The vessel was sealed and the reaction mixture was stirred atapproximately 230-235 rpm and heated from 21° C. to 140-145° C. over 7.5hours and held at 140-145° C. for 10.5 hours, then heated to 210-215° C.over 6.5 hours where the maximum pressure of 295-300 psi was obtained,then held at 210-215° C. for 4 1.5 hours. Subsequently, the reactor wascooled to 45° C. over a period of 4.5 hours. The resulting white solidwas filtered with the aid of deionized water (1.0 KG). The solids werewashed with deionized water (40 L) until the pH of the eluting filtratewas less than 11 (10.54). A representative portion of the wet cake wasdried in vacuo (25 inches Hg) overnight at 100° C. to give 1,376 g(87.1%) of ZS-9 as a white solid.

As discussed in the '152 patent, the specific reactor configuration andprocess conditions of this Example demonstrated that higher capacityzirconium silicates could be achieved. For example, capacities rangingfrom 3.8-3.9 meq/g were achieved relative to prior processes that onlyachieved capacities in the range of 1.7-2.3 meq/g.

The inventors have found, however, that material produced in accordancewith this Example exhibits a lead content of 0.6 ppm. The lead contentis determined using Inductively Coupled Plasma-Mass Spectrometry(ICP-MS). The samples were prepared with a 0.1 g weighed portion mixedwith 0.5 mL hydrofluoric acid, 2 mL nitric acid, 1 mL hydrochloric acid,and 1 mL purified water. The sample is digested using a closed-vesselmicrowave system at a maximum of 200° C. until the material appeareddissolved. After cooling, internal standard solution was added anddilution with purified water to 50 g produced solutions for ICP-MS.

The main contribution of lead to the zirconium silicate product comesfrom the reactants zirconium acetate and sodium silicate. This exampleillustrates that even when reagent grade materials (sodium silicate,zirconium acetate) are used as reactants, the level of lead can exceedthat which is acceptable.

Example 2

This example illustrates the production of zirconium silicate from thereaction of sodium silicate and zirconium acetate in a 500-L reactor.Sodium silicate (148.8 kg) and water (100.1 kg) were added to a 500-Lreactor and stirred at a rate of 200 rpm. Sodium hydroxide (37.7 kg) wasadded and the remaining water (100.2 kg) was added. The agitation ratewas lowered to 80 rpm and zirconium acetate (62.0 kg) was added alongwith water (49.4 kg) and the reactor was allowed to mix for 25-35minutes. The reactor was heated to react the materials 210±5° C. for ≥48hours at 140 rpm. The resultant material was protonated to a pH of 4.75to 5.25 and dried to a moisture content of ≤5.0%.

The composition has a volume weighted mean of 21.8 microns and a surfaceweighted mean of 13.56 microns. The material contains less than 0.05% ofits volume under 1 micron, and less than 1.41% under 3 microns. Theresultant material exhibits the characteristic XRD plot for ZS-9. Thereare undetectable levels of ZS-8 as shown by the absence of please withinthe range of 5-10 2-theta. As described in the inventors' prior patents,this material having a reduced amount of particulate fines and lackingsoluble forms of zirconium silicate (ZS-8) is suitable for oraladministration, for example in the treatment of hyperkalemia.

The inventors have found, however, that material produced in accordancewith this example exhibits levels of lead above the suitable level giventhe required dosing of the drug. See Table 2 below. In particular, theresulting product was found to have a level of lead of 1.0 ppm. The maincontribution of lead to the zirconium silicate product comes from thereactants zirconium acetate (0.28 ppm) and sodium silicate (0.38 ppm).Forms of zirconium acetate having lower levels of lead are unavailableon a commercial scale. Although other forms of silicate, colloidalsilica, were found having undetectable levels of lead, colloidal silicais unsuitable in the above process for reaction with zirconium acetateto form zirconium silicate. The inventors have found that the level oflead in the final product tends to be higher when the level of lead inthe reagents is uncontrolled, which can be the case with bulk suppliersof these reagents. Similar levels of lead on the order of 1-1.1 ppm wereobserved when the reaction was conducted at a scale of 200-L and 500-Lin reactor volume.

Example 3

This example illustrates the production of zirconium silicate from thereaction of colloidal silica and zirconium acetate in a 500-L reactor.The inventors found that in order to react colloidal silica withzirconium acetate, the process must include additional steps anddifferent agitation rates. For example, the colloidal silica processrequires a step of increased agitation (200 rpm) for ≥20 minutes tobreak silica bonds and obtain a well mixed solution. The inventors foundthat through this process the level of lead could be lowered below 1ppm, and as shown below can be lowered to 0.38 ppm in a 500-L reactor.

Sodium hydroxide (97.2 kg) is mixed with 84.5 kg of water and agitatedat 150 rpm while 108.8 kg colloidal silica (Ludox®) is added. Agitationcontinues at the same rate while 10.5 kg water is used to clear thecolloidal silica from the charge line into the reactor. Once thecolloidal silica is charged to the reactor, the agitation is increasedto 200 rpm for at least 20 minutes to break the silica bonds and obtaina well mixed solution. The agitation is reduced to 100 rpm whileadditional 52.9 kg water is added, and then increased to 200 rpm for atleast five more minutes.

The agitation is then decreased to 150 rpm while 81.0 kg of zirconiumacetate is added over a period of approximately 30 minutes. Water (62.8kg) is added and stirring continued for about 30 minutes prior toheating.

The reactor is heated to 210° C. as quickly as possible while mixing at150 rpm. The reactor is maintained at 210±5° C. for at least 36 hours.Upon completion, the material is protonated twice to a pH within therange of 4.75 to 5.25. The material is dried to a moisture content ofless than 5% by heating at 160° C. for 30 minutes.

The particle size distribution of the resulting zirconium silicateprepared in accordance with this example is shown in FIG. 4. Thecomposition exhibited a particle size distribution of about 2% below 3microns. The XRD plot showed the characteristics for ZS-9, includingthat the tow highest peaks occur at approximately 15.5 and 28.9, withthe highest peak occurring at approximately 28.9. There are undetectablelevels of ZS-8 as shown by the absence of please within the range of5-10 2-theta. See FIG. 5. The resultant zirconium silicate was a whitefree flowing powder essentially free of debris and particulars. The FTIRspectra exhibited bands at approximately 799 and 917 cm⁻¹ which wereconsistent with previously acceptable lots. The suitable FTIR spectra isshown in the inventors' prior patents. The pH of the resulting materialwas 9. The measured potassium loading capacity was 3.5 mEq/g. Thezirconium content was about 21.7%, the silicon content was approximately17%, and the sodium content was approximately 7.3%. The moisture contentof the final product was 5%.

The level of lead in the final product produced by the above processusing colloidal silica was 0.38 ppm, which is a suitable level for thelong term administration of this composition.

Other embodiments and uses of the invention will be apparent to thoseskilled in the art from consideration of the specification and practiceof the invention disclosed herein. All references cited herein,including all U.S. and foreign patents and patent applications, arespecifically and entirely hereby incorporated herein by reference. It isintended that the specification and examples be considered exemplaryonly, with the true scope and spirit of the invention indicated by thefollowing claims.

ANALYSIS TABLE 2 500-L Process w/NaAc - Example 2 Example 3 AcceptanceZirconium Sodium Zirconium Zirconium Colloidal Zirconium criteria (ppm)Acetate Silicate Silicate Acetate Silica Silicate Arsenic 1.5 ND ND NDND 0.06 ND Cadmium 0.5 0.05 ND ND 0.05 ND ND Copper 300 ND 0.09 0.570.05 0.08 0.19 Iridium 10 ND ND ND ND ND ND Lead 0.5 0.28 0.38 1.00 0.13ND 0.38 Mercury 3 ND ND ND ND ND ND Molybdenum 300 0.45 0.37 0.46 0.42ND 1.2  Nickel 20 ND ND 2.79 ND ND 2.56 Palladium 10 ND ND ND ND ND NDPlatinum 10 ND ND ND ND ND ND Rhodium 10 ND ND ND ND ND ND Ruthenium 10ND ND ND ND ND ND Vanadium 10 ND ND ND ND 0.33 ND

The invention claimed is:
 1. A cation exchange composition comprising azirconium silicate of formula (I):A_(p)M_(x)Zr_(1-x)Si_(n)Ge_(y)O^(m)  (I) where A is a potassium ion,sodium ion, rubidium ion, cesium ion, calcium ion, magnesium ion,hydronium ion or mixtures thereof, M is at least one framework metal,wherein the framework metal is hafnium (4+), tin (4+), niobium (5+),titanium (4+), cerium (4+), germanium (4+), praseodymium (4+), terbium(4+) or mixtures thereof, “p” has a value from about 1 to about 20, “x”has a value from 0 to less than 1, “n” has a value from about 0 to about12, “y” has a value from 0 to about 12, “m” has a value from about 3 toabout 36 and 1≤n+y≤12, wherein the zirconium silicate exhibits a leadcontent below 0.6 ppm.
 2. The composition of claim 1, wherein the leadcontent ranges from 0.1 to 0.5 ppm.
 3. The composition of claim 1,wherein the lead content ranges from 0.3 to 0.5 ppm.
 4. The compositionof claim 1, wherein the lead content ranges from 0.3 to 0.45 ppm.
 5. Thecomposition of claim 1, wherein the composition comprises less than 7%particles having a diameter less than 3 microns.
 6. The composition ofclaim 5, wherein less than 0.5% of the particles in the composition havea diameter less than 1 microns.
 7. The composition of claim 1, whereinthe composition comprises less than 7% particles having a diameter lessthan 3 microns, and the sodium content is below 12%.
 8. The compositionof claim 1, wherein the composition comprises less than 7% particleshaving a diameter less than 3 microns, and the sodium content is 9% orless.
 9. The composition of claim 1, wherein the pH of the compositionranges from 7 to
 9. 10. The composition of claim 1, wherein thepotassium loading capacity is between 2.7 and 3.7 mEq/g.
 11. Thecomposition of claim 1, wherein the potassium loading capacity isapproximately 3.5 mEq/g.
 12. A method for treatment of hyperkalemiacomprising administering the composition of claim 1 to a patient in needthereof.
 13. The composition of claim 1, wherein the compositioncomprises less than 3% particles having a diameter less than 3 microns.14. The composition of claim 1, wherein the zirconium silicate ispredominately ZS-9.
 15. The composition of claim 1, wherein thezirconium silicate is predominately ZS-9 and the potassium loadingcapacity is between 2.7 and 3.7 mEq/g.
 16. A cation exchange compositioncomprising a zirconium silicate of formula (I):A_(p)M_(x)Zr_(1-x)Si_(n)Ge_(y)O^(m)  (I) where A is a potassium ion,sodium ion, rubidium ion, cesium ion, calcium ion, magnesium ion,hydronium ion or mixtures thereof, M is at least one framework metal,wherein the framework metal is hafnium (4+), tin (4+), niobium (5+),titanium (4+), cerium (4+), germanium (4+), praseodymium (4+), terbium(4+) or mixtures thereof, “p” has a value from about 1 to about 20, “x”has a value from 0 to less than 1, “n” has a value from about 0 to about12, “y” has a value from 0 to about 12, “m” has a value from about 3 toabout 36 and 1≤n+y≤12, wherein the zirconium silicate is predominatelyZS-9 and exhibits a lead content that ranges from ranges from 0.1 tobelow 0.6 ppm, and has a potassium loading capacity between 2.7 and 3.7mEq/g.
 17. The composition of claim 16, wherein the lead content rangesfrom 0.3 to 0.45 ppm.
 18. The composition of claim 16, wherein thecomposition comprises less than 7% particles having a diameter less than3 microns.
 19. The composition of claim 18, wherein less than 0.5% ofthe particles in the composition have a diameter less than 1 microns.20. The composition of claim 16, wherein the composition comprises lessthan 7% particles having a diameter less than 3 microns, and the sodiumcontent is below 12%.
 21. The composition of claim 16, wherein thecomposition comprises less than 7% particles having a diameter less than3 microns, and the sodium content is 9% or less.
 22. The composition ofclaim 16, wherein the pH of the composition ranges from 7 to 9.